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Article(id=1311349817226392158, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508331, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1755878400000, receivedDateStr=2025-08-23, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579760127, onlineDateStr=2026-09-28, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579760127, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579760127, creator=13701087609, updateTime=1790579760127, updator=13701087609, issue=Issue{id=1311349802038821144, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579756507, creator='13701087609', updateTime=1790588376143, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385955492258162, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385955496452467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2327, endPage=2332, ext={EN=ArticleExt(id=1311349817444495967, articleId=1311349817226392158, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Prospective association between changes in intrinsic capacity and risk of cardiovascular disease in middle-aged and older adults, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between changes in intrinsic capacity (IC) and the risk of cardiovascular disease (CVD) among middle-aged and older adults.

Methods

A total of 2 858 participants from the China Health and Retirement Longitudinal Study (CHARLS) 2011—2018 were included. IC impairment groups were constructed based on changes in five IC domains (locomotion, vitality, cognition, psychological, and sensory) between 2011 and 2013. Cox proportional hazards regression was employed to assess the association between IC changes and CVD. Subgroup and sensitivity analyses were also conducted.

Results

During the 7-year follow-up, 526 (18.4%) incident CVD events were recorded. Compared with the intact group, the hazard ratios (HRs) for incident CVD were 1.47 (95% CI: 1.09-1.99) for the improved group, 1.43 (95% CI: 1.09-1.86) for the persistently mildly impaired group, and 1.74 (95% CI: 1.28-2.37) for the persistently severely impaired group. Compared with the persistently impaired group, the risk of CVD was lower in the improved group (HR=0.58, 95% CI: 0.45-0.76). Subgroup analysis showed an interaction between IC changes and age (P for interaction <0.05).

Conclusion

Persistent IC impairment significantly increases the risk of cardiovascular disease, with risk rising progressively according to the severity of impairment, whereas improvements in intrinsic capacity are associated with a reduced risk.

, authors=Lu-lu TANG1, 2, Chang-cui QIU1, 2, Chun-wei CHI1, Fei LIU1, Xiao-ping ZHU1, Xiao-li YU1, authorsList=Lu-lu TANG, Chang-cui QIU, Chun-wei CHI, Fei LIU, Xiao-ping ZHU, Xiao-li YU, authorCompany=null, correspAuthors=Xiao-ping ZHU, Xiao-li YU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311349820309205608, articleId=1311349817226392158, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中老年人内在能力变化与心血管疾病风险的前瞻性研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探讨中老年人内在能力变化与心血管疾病（cardiovascular disease，CVD）发病风险的关联。

方法

基于中国健康与养老追踪调查2011—2018年数据，纳入2 858名研究对象。根据2011和2013年内在能力五个维度（运动、活力、认知、心理、感觉）的变化构建内在能力受损分组。采用Cox比例风险回归模型分析内在能力变化与CVD风险的关联，并进行亚组分析和敏感性分析。

结果

在7年随访中共526人（18.4%）被诊断为CVD。与完整组相比，改善组（HR=1.47，95%CI：1.09～1.99）、持续轻度受损组（HR=1.43，95%CI：1.09～1.86）和持续重度受损组（HR=1.74，95%CI：1.28～2.37）CVD发病风险增加。与持续受损组相比，改善组CVD发病风险降低（HR=0.58，95%CI：0.45～0.76）。亚组分析显示内在能力变化与年龄存在交互作用（P<0.05）。

结论

内在能力持续受损显著增加CVD风险，且随受损程度加重风险递增；内在能力改善可降低该风险。

, authors=唐路路1, 2, 邱昌翠1, 2, 迟春薇1, 刘菲1, 朱晓萍1, 于晓丽1, authorsList=唐路路, 邱昌翠, 迟春薇, 刘菲, 朱晓萍, 于晓丽, authorCompany=null, correspAuthors=朱晓萍, 于晓丽, authorNote=

唐路路（1997—），男，博士在读，研究方向：重症护理、老年护理

, correspAuthorsNote=
朱晓萍，E-mail：
于晓丽，E-mail：
朱晓萍与于晓丽为共同通信作者
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唐路路（1997—），男，博士在读，研究方向：重症护理、老年护理

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(In Chinese), articleTitle=Correlation between intrinsic capacity and activities of daily living in Chinese older adults: based on CHARLS data, refAbstract=null)], funds=[Fund(id=1311349825879241381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, awardId=72074168, language=CN, fundingSource=国家自然科学基金面上项目(72074168), fundOrder=null, country=null), Fund(id=1311349825946350246, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, awardId=SHDC22024207, language=CN, fundingSource=上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC22024207), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311349820544086633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, xref=1., ext=[AuthorCompanyExt(id=1311349820552475242, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, companyId=1311349820544086633, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Nursing, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China), AuthorCompanyExt(id=1311349820565058155, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, companyId=1311349820544086633, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.同济大学附属第十人民医院护理部，上海 200072)]), AuthorCompany(id=1311349820640555628, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, xref=2., ext=[AuthorCompanyExt(id=1311349820644749933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, companyId=1311349820640555628, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.同济大学医学院，上海 200331)])], figs=[ArticleFig(id=1311349824587395735, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Figure 1, caption=Flow chart of participant selection, figureFileSmall=wtSv62Fxs5f8XUExHKDD0g==, figureFileBig=kJ+APH0GpaNX1c5eB2cbkA==, tableContent=null), ArticleFig(id=1311349824662893208, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=图1, caption=研究对象筛选流程图, figureFileSmall=wtSv62Fxs5f8XUExHKDD0g==, figureFileBig=kJ+APH0GpaNX1c5eB2cbkA==, tableContent=null), ArticleFig(id=1311349824868414105, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Figure 2, caption=Comparison of cumulative incidence of CVD by intrinsic capacity, figureFileSmall=Y6ylbSmSjYYnU8Ybo/WHTQ==, figureFileBig=d51DcT0Q0eD6shFV8t5HLA==, tableContent=null), ArticleFig(id=1311349824939717274, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=图2, caption=内在能力与CVD的累积发生率比较, figureFileSmall=Y6ylbSmSjYYnU8Ybo/WHTQ==, figureFileBig=d51DcT0Q0eD6shFV8t5HLA==, tableContent=null), ArticleFig(id=1311349825006826139, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Table 1, caption=

Baseline characteristics of study participants ［（）， n（%）］

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特征总人群（n=2 858）完整（n=597）衰退（n=447）改善（n=478）持续受损（n=1 336）
年龄（岁）60.0±6.758.9±6.159.5±6.759.4±6.260.9±7.1
BMI（kg/m2）23.4±3.524.2±3.423.5±3.223.8±3.422.8±3.6
性别
女1 214 (42.5)201 (33.7)161 (36.0)194 (40.6)658 (49.3)
男1 644 (57.5)396 (66.3)286 (64.0)284 (59.4)678 (50.7)
受教育程度
高中以下2 504 (87.6)471 (78.9)376 (84.1)414 (86.6)1 243 (93.0)
高中327 (11.4)112 (18.8)67 (15.0)60 (12.6)88 (6.6)
大学及以上27 (0.9)14 (2.3)4 (0.9)4 (0.8)5 (0.4)
婚姻状况
已婚2 587 (90.5)567 (95.0)407 (91.1)422 (88.3)1 191 (89.1)
未婚及其他271 (9.5)30 (5.0)40 (8.9)56 (11.7)145 (10.9)
家庭总财富
低601 (27.7)70 (16.1)81 (23.8)92 (26.5)358 (34.2)
中776 (35.8)143 (32.9)110 (32.4)132 (38.0)391 (37.3)
高792 (36.5)222 (51.0)149 (43.8)123 (35.4)298 (28.5)
吸烟状况
从不1 534 (53.7)293 (49.1)225 (50.3)254 (53.1)762 (57.0)
曾经270 (9.4)67 (11.2)45 (10.1)41 (8.6)117 (8.8)
现在1 054 (36.9)237 (39.7)177 (39.6)183 (38.3)457 (34.2)
饮酒状况
曾经1 752 (61.3)329 (55.1)270 (60.4)280 (58.6)873 (65.3)
现在1 106 (38.7)268 (44.9)177 (39.6)198 (41.4)463 (34.7)
高血压1 102 (38.8)219 (36.9)172 (38.5)175 (36.8)536 (40.5)
糖尿病202 (8.9)36 (7.6)22 (6.2)33 (8.7)111 (10.4)
), ArticleFig(id=1311349825099100828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=表1, caption=

研究对象基线特征 ［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人群（n=2 858）完整（n=597）衰退（n=447）改善（n=478）持续受损（n=1 336）
年龄（岁）60.0±6.758.9±6.159.5±6.759.4±6.260.9±7.1
BMI（kg/m2）23.4±3.524.2±3.423.5±3.223.8±3.422.8±3.6
性别
女1 214 (42.5)201 (33.7)161 (36.0)194 (40.6)658 (49.3)
男1 644 (57.5)396 (66.3)286 (64.0)284 (59.4)678 (50.7)
受教育程度
高中以下2 504 (87.6)471 (78.9)376 (84.1)414 (86.6)1 243 (93.0)
高中327 (11.4)112 (18.8)67 (15.0)60 (12.6)88 (6.6)
大学及以上27 (0.9)14 (2.3)4 (0.9)4 (0.8)5 (0.4)
婚姻状况
已婚2 587 (90.5)567 (95.0)407 (91.1)422 (88.3)1 191 (89.1)
未婚及其他271 (9.5)30 (5.0)40 (8.9)56 (11.7)145 (10.9)
家庭总财富
低601 (27.7)70 (16.1)81 (23.8)92 (26.5)358 (34.2)
中776 (35.8)143 (32.9)110 (32.4)132 (38.0)391 (37.3)
高792 (36.5)222 (51.0)149 (43.8)123 (35.4)298 (28.5)
吸烟状况
从不1 534 (53.7)293 (49.1)225 (50.3)254 (53.1)762 (57.0)
曾经270 (9.4)67 (11.2)45 (10.1)41 (8.6)117 (8.8)
现在1 054 (36.9)237 (39.7)177 (39.6)183 (38.3)457 (34.2)
饮酒状况
曾经1 752 (61.3)329 (55.1)270 (60.4)280 (58.6)873 (65.3)
现在1 106 (38.7)268 (44.9)177 (39.6)198 (41.4)463 (34.7)
高血压1 102 (38.8)219 (36.9)172 (38.5)175 (36.8)536 (40.5)
糖尿病202 (8.9)36 (7.6)22 (6.2)33 (8.7)111 (10.4)
), ArticleFig(id=1311349825182986909, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Table 2, caption=

Multivariable Cox regression analysis of intrinsic capacity and CVD risk

, figureFileSmall=null, figureFileBig=null, tableContent=
组别发病人数/人年模型1模型2模型3
HR (95% CI)P值HR (95% CI)P值HR (95% CI)P值
完整a84/2 8811.001.001.00
衰退76/2 1461.22 (0.89～1.66)0.2151.19 (0.87～1.62)0.2781.26 (0.92～1.72)0.278
改善90/2 2881.35 (1.00～1.82)0.0471.32 (0.98～1.78)0.0661.42 (1.05～1.92)0.066
持续受损276/6 3441.51 (1.18～1.93)0.0011.39 (1.09～1.78)0.0091.51 (1.17～1.95)<0.001
持续受损b276/6 3441.001.001.00
改善90/2 2880.66 (0.52～0.85)<0.0010.63 (0.49～0.81)<0.0010.58 (0.45～0.76)<0.001
), ArticleFig(id=1311349825266872990, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=表2, caption=

内在能力与CVD风险的多因素Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别发病人数/人年模型1模型2模型3
HR (95% CI)P值HR (95% CI)P值HR (95% CI)P值
完整a84/2 8811.001.001.00
衰退76/2 1461.22 (0.89～1.66)0.2151.19 (0.87～1.62)0.2781.26 (0.92～1.72)0.278
改善90/2 2881.35 (1.00～1.82)0.0471.32 (0.98～1.78)0.0661.42 (1.05～1.92)0.066
持续受损276/6 3441.51 (1.18～1.93)0.0011.39 (1.09～1.78)0.0091.51 (1.17～1.95)<0.001
持续受损b276/6 3441.001.001.00
改善90/2 2880.66 (0.52～0.85)<0.0010.63 (0.49～0.81)<0.0010.58 (0.45～0.76)<0.001
), ArticleFig(id=1311349825346564767, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Table 3, caption=

Multivariable Cox regression analysis of the degree of intrinsic capacity impairment and CVD risk

, figureFileSmall=null, figureFileBig=null, tableContent=
组别发病人数/人年模型1模型2模型3
HR (95% CI)P值HR (95% CI)P值HR (95% CI)P值
完整84/2 8811.001.001.00
衰退76/2 1461.22 (0.89～1.66)0.2151.19 (0.87～1.62)0.2781.26 (0.92～1.72)0.278
改善90/2 2881.35 (1.00～1.82)0.0471.32 (0.98～1.78)0.0661.42 (1.05～1.92)0.066
持续轻度受损181/4 2141.42 (1.18～1.93)0.0011.33 (1.03～1.73)0.0391.43 (1.09～1.86)0.008
持续重度受损95/2 1301.72 (1.29～2.31)<0.0011.53 (1.13～20.6)0.0051.74 (1.28～2.37)<0.001
), ArticleFig(id=1311349825422062240, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=表3, caption=

内在能力受损程度与CVD风险的多因素Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别发病人数/人年模型1模型2模型3
HR (95% CI)P值HR (95% CI)P值HR (95% CI)P值
完整84/2 8811.001.001.00
衰退76/2 1461.22 (0.89～1.66)0.2151.19 (0.87～1.62)0.2781.26 (0.92～1.72)0.278
改善90/2 2881.35 (1.00～1.82)0.0471.32 (0.98～1.78)0.0661.42 (1.05～1.92)0.066
持续轻度受损181/4 2141.42 (1.18～1.93)0.0011.33 (1.03～1.73)0.0391.43 (1.09～1.86)0.008
持续重度受损95/2 1301.72 (1.29～2.31)<0.0011.53 (1.13～20.6)0.0051.74 (1.28～2.37)<0.001
), ArticleFig(id=1311349825497559713, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Table 4, caption=

Subgroup analyses by age and sex for the association between intrinsic capacity and CVD risk

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组HR (95% CI)交互作用P值
年龄（岁）0.032
≥60完整1.00
衰退1.11 (0.71～1.71)
改善1.31 (0.87～1.99)
持续受损1.43 (1.02～2.01)
45～60完整1.00
衰退1.48 (0.94～2.31)
改善1.59 (1.03～2.46)
持续受损1.72 (1.18～2.51)
性别0.088
男性完整1.00
衰退1.27 (0.86～1.89)
改善1.28 (0.86～1.89)
持续受损1.45 (1.04～2.02)
女性完整1.00
衰退1.26 (0.75～2.12)
改善1.64 (1.02～2.61)
持续受损1.61 (1.08～2.41)
), ArticleFig(id=1311349825589834402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=表4, caption=

内在能力与CVD风险的年龄、性别亚组分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组HR (95% CI)交互作用P值
年龄（岁）0.032
≥60完整1.00
衰退1.11 (0.71～1.71)
改善1.31 (0.87～1.99)
持续受损1.43 (1.02～2.01)
45～60完整1.00
衰退1.48 (0.94～2.31)
改善1.59 (1.03～2.46)
持续受损1.72 (1.18～2.51)
性别0.088
男性完整1.00
衰退1.27 (0.86～1.89)
改善1.28 (0.86～1.89)
持续受损1.45 (1.04～2.02)
女性完整1.00
衰退1.26 (0.75～2.12)
改善1.64 (1.02～2.61)
持续受损1.61 (1.08～2.41)
), ArticleFig(id=1311349825665331875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=EN, label=Table 5, caption=

Sensitivity analyses

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3
HR (95% CI)P值HR (95% CI)P值HR (95% CI)P值
完整1.001.001.00
衰退1.23 (0.91～1.65)0.1791.19 (0.87～1.57)0.3251.16 (0.86～1.57)0.311
改善1.51 (1.16～1.97)0.0021.44 (1.11～1.88)0.0021.49 (1.14～1.94)0.003
持续受损1.83 (1.52～2.19)<0.0011.70 (1.41～2.05)<0.0011.71 (1.41～2.06)<0.001
持续轻度受损a1.41 (1.09～1.84)0.0171.37 (1.06～1.78)0.0021.57 (1.20～2.06)<0.001
持续重度受损a1.63 (1.21～2.21)0.0011.59 (1.18～2.14)<0.0011.93 (1.42～2.64)<0.001
), ArticleFig(id=1311349825745023652, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349817226392158, language=CN, label=表5, caption=

敏感性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3
HR (95% CI)P值HR (95% CI)P值HR (95% CI)P值
完整1.001.001.00
衰退1.23 (0.91～1.65)0.1791.19 (0.87～1.57)0.3251.16 (0.86～1.57)0.311
改善1.51 (1.16～1.97)0.0021.44 (1.11～1.88)0.0021.49 (1.14～1.94)0.003
持续受损1.83 (1.52～2.19)<0.0011.70 (1.41～2.05)<0.0011.71 (1.41～2.06)<0.001
持续轻度受损a1.41 (1.09～1.84)0.0171.37 (1.06～1.78)0.0021.57 (1.20～2.06)<0.001
持续重度受损a1.63 (1.21～2.21)0.0011.59 (1.18～2.14)<0.0011.93 (1.42～2.64)<0.001
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中老年人内在能力变化与心血管疾病风险的前瞻性研究
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唐路路 1, 2 , 邱昌翠 1, 2 , 迟春薇 1 , 刘菲 1 , 朱晓萍 1 , 于晓丽 1
现代预防医学 | 流行病与统计方法 2026,53(13): 2327-2332
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现代预防医学 |流行病与统计方法 2026 , 53 (13) : 2327 -2332
中老年人内在能力变化与心血管疾病风险的前瞻性研究
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唐路路1, 2, 邱昌翠1, 2, 迟春薇1, 刘菲1, 朱晓萍1 , 于晓丽1
作者信息
  • 1.同济大学附属第十人民医院护理部，上海 200072
  • 2.同济大学医学院，上海 200331
通讯作者:
朱晓萍，E-mail：
于晓丽，E-mail：
朱晓萍与于晓丽为共同通信作者
作者简介:

唐路路（1997—），男，博士在读，研究方向：重症护理、老年护理

Prospective association between changes in intrinsic capacity and risk of cardiovascular disease in middle-aged and older adults
Lu-lu TANG1, 2, Chang-cui QIU1, 2, Chun-wei CHI1, Fei LIU1, Xiao-ping ZHU1 , Xiao-li YU1
Affiliations
  • Department of Nursing, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China
出版时间: 2026-07-10 doi: 10.20043/j.cnki.MPM.202508331
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摘要
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目的

探讨中老年人内在能力变化与心血管疾病（cardiovascular disease，CVD）发病风险的关联。

方法

基于中国健康与养老追踪调查2011—2018年数据，纳入2 858名研究对象。根据2011和2013年内在能力五个维度（运动、活力、认知、心理、感觉）的变化构建内在能力受损分组。采用Cox比例风险回归模型分析内在能力变化与CVD风险的关联，并进行亚组分析和敏感性分析。

结果

在7年随访中共526人（18.4%）被诊断为CVD。与完整组相比，改善组（HR=1.47，95%CI：1.09～1.99）、持续轻度受损组（HR=1.43，95%CI：1.09～1.86）和持续重度受损组（HR=1.74，95%CI：1.28～2.37）CVD发病风险增加。与持续受损组相比，改善组CVD发病风险降低（HR=0.58，95%CI：0.45～0.76）。亚组分析显示内在能力变化与年龄存在交互作用（P<0.05）。

结论

内在能力持续受损显著增加CVD风险，且随受损程度加重风险递增；内在能力改善可降低该风险。

内在能力  /  心血管疾病  /  动态变化  /  中老年人
Objective

To investigate the association between changes in intrinsic capacity (IC) and the risk of cardiovascular disease (CVD) among middle-aged and older adults.

Methods

A total of 2 858 participants from the China Health and Retirement Longitudinal Study (CHARLS) 2011—2018 were included. IC impairment groups were constructed based on changes in five IC domains (locomotion, vitality, cognition, psychological, and sensory) between 2011 and 2013. Cox proportional hazards regression was employed to assess the association between IC changes and CVD. Subgroup and sensitivity analyses were also conducted.

Results

During the 7-year follow-up, 526 (18.4%) incident CVD events were recorded. Compared with the intact group, the hazard ratios (HRs) for incident CVD were 1.47 (95% CI: 1.09-1.99) for the improved group, 1.43 (95% CI: 1.09-1.86) for the persistently mildly impaired group, and 1.74 (95% CI: 1.28-2.37) for the persistently severely impaired group. Compared with the persistently impaired group, the risk of CVD was lower in the improved group (HR=0.58, 95% CI: 0.45-0.76). Subgroup analysis showed an interaction between IC changes and age (P for interaction <0.05).

Conclusion

Persistent IC impairment significantly increases the risk of cardiovascular disease, with risk rising progressively according to the severity of impairment, whereas improvements in intrinsic capacity are associated with a reduced risk.

Intrinsic capacity  /  Cardiovascular disease  /  Dynamic change  /  Middle-aged and older adults
唐路路, 邱昌翠, 迟春薇, 刘菲, 朱晓萍, 于晓丽. 中老年人内在能力变化与心血管疾病风险的前瞻性研究. 现代预防医学, 2026 , 53 (13) : 2327 -2332 . DOI: 10.20043/j.cnki.MPM.202508331
Lu-lu TANG, Chang-cui QIU, Chun-wei CHI, Fei LIU, Xiao-ping ZHU, Xiao-li YU. Prospective association between changes in intrinsic capacity and risk of cardiovascular disease in middle-aged and older adults[J]. Modern Preventive Medicine, 2026 , 53 (13) : 2327 -2332 . DOI: 10.20043/j.cnki.MPM.202508331
正文
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心血管疾病（cardiovascular disease，CVD）已成为导致中老年人死亡和致残的主要疾病[1]。《中国心血管健康与疾病报告2024》[2]报告指出，2019年全人群CVD的发病数为1 234.11万例，且预计未来十年仍将持续攀升。为应对日益加剧的老龄化趋势，世界卫生组织（World Health Organization,WHO）于2015年提出健康老龄化策略，强调内在能力（intrinsic capacity）在促进健康老龄化中的关键作用[3]。内在能力包括运动、活力、认知、心理和感觉五个维度，是衡量个体维持独立生活能力的重要指标[4]。既往研究已证实，内在能力的单次评估与多种不良结局相关[5-6]。然而，内在能力具有高度动态性，其短期变化更能反映健康状况的转变。近年来，已有部分研究已开始探索内在能力变化轨迹对健康结局的预测价值，初步证实内在能力恶化可能是健康衰退的早期预警信号，但内在能力改善能否逆转不良风险，目前证据仍不充分，尤其对CVD研究尚属空白。本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据，探究中老年人内在能力变化与CVD发病风险的关联，并进一步探索年龄和性别的调节作用，以期为内在能力监测及CVD早期干预提供科学依据。
1　资料与方法
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1.1　资料来源
数据来源于CHARLS 2011、2013、2015和2018年的随访数据。调查对象为45岁及以上的中老年人群，涵盖全国28个省（自治区、直辖市）的150个县，其中基线调查开始于2011年，共纳入17 708名研究对象，并对45岁及以上人群每2年追踪随访一次，调查内容主要涉及中老年人群的基本情况、社会支持、健康状况等。CHARLS项目已通过北京大学生物医学伦理审查委员会的批准（批准号：IRB00001052-11015)，研究对象均签署知情同意书。本研究以CHARLS第一轮（2011年）、第二轮（2013年）评估内在能力变化，CVD追踪至2018年。纳入标准：基线调查时未发生CVD；参与基线及随访调查。排除标准：未完成内在能力评估；缺失协变量。最终纳入2 858名研究对象，研究对象筛选流程见图1。
1.2　研究内容与方法
1.2.1　CVD
CVD定义为研究对象自我报告的医生确诊心脏病或卒中。在每次调查阶段，研究人员通过询问研究对象“是否曾被医生告知患有心脏病（包括心绞痛、心肌梗死、充血性心力衰竭及其他心脏问题）”及“否曾被医生告知患有卒中”。若研究对象自述曾被诊断出上述病症，则视为存在CVD。为减少回忆偏倚和信息错误，后续调查阶段，若研究对象在前次调查中报告了心脏病或卒中，则需再次确认其真实性。当研究对象对否认先前自述的心脏病或卒中诊断时，将进行追溯性修正。既往研究表明，CHARLS中研究对象自我报告的疾病诊断与医疗记录具有较高的一致性[7]。
1.2.2　内在能力
依据WHO推荐评估运动、活力、认知、心理和感觉五个维度。（1）运动：依据4m正常步速进行评估，速度<0.8m/s为受损。（2）活力：以身体质量指数（body mass index,BMI）作为测量指标，BMI≤18.5 kg/m2定义为活力受损[8]。（3）认知：采用简易精神状态检查（mini-mental state examination，MMSE）进行评估。结合研究对象的受教育水平及得分定义认知功能障碍，文盲<17分、小学程度<20分、中学程度(包括中专)<22分、大学程度(包括大专)<23分[9]。（4）心理：采用流调中心抑郁量表（center for epidemiologic studies depression scale, CES-D）测量，总分0～30分，得分≥10分提示存在抑郁症状。（5）感觉：通过自我报告的听力和视力状况进行评估，听力和视力存在任一受损即为感觉受损。内在能力受损定义为五个领域中的任何一个受损，否则为内在能力完整。根据2011和2013年的内在能力状态定义了四个内在能力变化：完整（2011和2013年均完整）、衰退（2011年完整而2013年受损）、改善（2011年受损而2013年完整）和持续受损（2011和2013年均受损）。采用各维度相加计分方式，受损计0分，正常计1分，定义内在能力受损变化为：完整组、衰退组、改善组、持续轻度受损组（任一领域受损）和持续重度受损组（≥ 2个领域受损）。
1.2.3　协变量
基于有向无环图确定纳入本研究的协变量，包括年龄、性别、受教育程度、婚姻状况、家庭总资产、吸烟和饮酒状况、高血压、糖尿病。吸烟定义为当前吸烟、曾经吸烟或从不吸烟；饮酒定义为当前饮酒或曾经饮酒。高血压定义为收缩压≥140mm Hg或舒张压≥ 90mm Hg或自我报告的高血压诊断史或使用任何抗高血压药物治疗。糖尿病定义为空腹血糖≥ 7.0mmol/L或随机血糖≥ 11.1mmol/L或自我报告的糖尿病诊断史或使用任何降糖药物。
1.2.4　统计学方法
采用R.4.5.1软件对数据进行分析，正态分布资料以（均数±标准差）表示，组间比较采用多因素方差分析；否则以中位数和四分位数间距［M（P25，P75）］表示，组间比较采用Kruskal-Wallis秩和检验；计数资料以频数或构成比（%）表示，组间比较采用χ2检验。采用Kaplan-Meier曲线、Cox比例风险回归模型分析内在能力变化与CVD风险的关联，采用Schofield残差法检验比例风险假设。结果以风险比和95%置信区间表示。采用分步模型调整潜在混杂因素：模型1是原始模型，未调整任何协变量；模型2调整年龄、性别；模型3在模型2的基础上调整基线时受教育程度、婚姻状况、家庭总资产、吸烟情况、饮酒情况、高血压、糖尿病。采用亚组分析年龄、性别在内在能力变化与CVD风险中的调节作用。敏感性分析活力采用握力指标评估，男性<28 kg、女性<18 kg定义为受损；运动能力采用5次坐站试验，完成时间≥ 14 s为受损。双侧检验，检验水准α=0.05。
2　结果
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2.1　研究对象基线特征
本研究共纳入2 858名研究对象，其中男性1 644名（57.5%），女性1 214名（42.5%）；基线平均年龄（60.0±6.7）岁；BMI为（23.4±3.5）kg/m2；高中以下学历2 504名（87.6%）；已婚2 587名（90.5%）。见表1。
2.2　内在能力与CVD风险的关联
随访期间共526名（18.4%）研究对象被首次诊断为CVD，完整组、衰退组、改善组、持续受损组分别有84、76、90和276例，发病率分别为29.2/千人年、35.4/千人年、39.3/千人年、43.5/千人年。Kaplan-Meier累积发生率曲线分析显示，随着随访时间的增加，4组CVD累积发生率均呈上升趋势，且4组CVD累积发生率差异具有统计学意义（P<0.01）。见图2。
以是否发生CVD为因变量（是=1，否=0）进行Cox风险比例回归模型分析，在全调整模型中（模型3），与内在能力完整组相比，改善组与持续受损组CVD发生风险显著增高，HR（95%CI）分别为1.42（1.05～1.92）和1.51（1.17～1.95）。以持续受损组为参照进行分析，改善组CVD发病风险显著降低（HR= 0.58,95% CI: 0.45～0.76）。见表2。
以内在能力受损程度为分组类别进行Cox风险比例回归模型分析，结果显示，与内在能力完整组相比，模型3持续轻度受损组人群发生CVD的风险增加了43%（HR=1.43, 95% CI: 1.09～1.86），持续重度受损组的风险增加了74%（HR=1.74, 95% CI: 1.28～2.37）。见表3。
2.3　亚组分析和敏感性分析
亚组分析结果显示，年龄是一个显著的效应修饰因素（P交互=0.03）。内在能力变化持续受损组与CVD风险的正向关联在45～60岁人群中更为显著（HR=1.72，95%CI:1.18～2.51），而在性别中未观察到显著的交互作用，见表4。敏感性分析显示采用五次坐立试验和握力指标重新定义内在能力后，结果无显著变化。见表5。
3　讨论
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本研究基于CHARLS纵向数据，探讨了中老年人内在能力变化轨迹与CVD发病风险的关联。结果显示，与内在能力完整者相比，内在能力改善和持续受损显著增加CVD发病风险，其中持续重度受损组风险最高（HR=1.74, 95% CI: 1.28～2.37），提示内在能力多维度受损的群体面临更高的心血管风险；与持续受损者相比，内在能力改善能显著降低CVD风险。年龄对该关联具有调节作用，内在能力变化对45～60岁人群CVD风险更高。
近年来，WHO提出“以功能为核心的健康老龄化”理念，强调通过维持和提升内在能力以降低疾病和功能障碍发生率[10]。本研究发现与内在能力完整者相比，改善组、持续轻度受损组及持续重度受损组均显著增加CVD发病风险，提示既往内在能力受损可能对心血管健康产生难以完全逆转的累积影响[11]。尤其是持续重度受损者，表明多系统功能受损叠加可能带来显著的病理风险。这与倪斐天等[12]关于内在能力下降与原发性肝癌发病风险呈剂量-反应关系的研究结果一致。既往的功能受损可能通过慢性炎症、内皮功能障碍或自主神经调节异常等机制[13-14]，留下了潜在的病理基础。然而，与持续受损组相比，内在能力改善组能显著降低CVD发病风险。这表明，虽然早期受损会遗留一定风险，但及时的功能恢复仍能有效阻断风险的进一步累积。这一发现与关于抑郁和体重等可逆因素对CVD影响一致[15-16]，即针对可改变的风险因素进行干预，即使不能完全消除既往损害，也能显著改善预后。因此，临床实践既要重视内存能力受损的早期预防，以减少“残留风险”；也要鼓励后期的功能康复，因为改善本身具有明确的保护效应。
内在能力涵盖运动、活力、认知、心理及感觉五个维度，其整体下降反映了多系统生理功能的减退，可能与CVD共同的病理生理基础密切相关[17-18]。尽管本研究证实内在能力变化持续受损与CVD发病风险增加密切相关，然而各维度的具体贡献及彼此间的相互作用机制仍有待系统阐明[19]。现有研究证实[20]，运动能力下降可能直接导致体力活动不足，进而增加CVD风险；认知障碍和抑郁症状则可能通过影响自我管理能力、治疗依从性以及生理应激反应等途径间接影响心血管健康[15]。未来研究可借助潜类别分析或结构方程建模等方法，探讨特定维度组合对CVD风险的具体贡献，以优化干预策略。
亚组分析显示，内在能力变化与CVD风险的关联在60岁以下人群中更强，提示中年时期内在能力变化更能敏感地反映早期健康恶化或不良生活方式的累积效应[21]。与老年期多重共病掩盖功能变化的情况不同，中年期的内在能力下降可能是心血管病变的早期预警信号。本研究与以往关于年龄在老年人功能衰退与健康风险中调节作用的报道一致，强调了疾病前状态干预的慢病前移管理策略的现实意义[22]。性别亚组分析未观察到显著差异。
尽管本研究采用CHARLS多轮随访数据，具备全国代表性和纵向跟踪优势，但也存在一些局限性。首先，CVD的诊断主要依赖于自我报告，尽管既往研究表明CHARLS数据中自我报告的疾病诊断具有较高的一致性，但仍可能存在信息偏差。其次，本研究未能深入探讨内在能力各维度对CVD风险的相对贡献。未来的研究可以通过引入更客观的生理指标和生物标志物，以更全面地阐明内在能力与CVD之间的复杂关系。
本研究发现内在能力变化与中老年人CVD发病风险密切相关，持续受损表现出较高的心血管风险，而内在能力改善能降低CVD发病风险。未来需在不同人群中进行验证，深入探讨其生物学机制，并探索在基层公共卫生实践中将内在能力变化评估整合到临床风险预测工具的可行性，并通过体力活动干预、营养改善、心理支持等多维度策略，延缓内在能力衰退。此外，还需开展干预性研究，评估通过多维度策略改善内在能力是否能降低CVD及其他老龄化相关疾病的风险。
基金
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  • 国家自然科学基金面上项目(72074168)
  • 上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC22024207)
文献
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2026年第53卷第13期
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doi: 10.20043/j.cnki.MPM.202508331
  • 接收时间：2025-08-23
  • 首发时间：2026-09-28
  • 出版时间：2026-07-10
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  • 收稿日期：2025-08-23
基金
国家自然科学基金面上项目(72074168)
上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC22024207)
作者信息
    1.同济大学附属第十人民医院护理部，上海 200072
    2.同济大学医学院，上海 200331

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